Background- what is this work about?
Sub-Saharan Africa has high maternal death rates, making up two thirds of maternal deaths across the world. One reason for this is inadequate staff training around anaesthesia use in practice, for example during caesarean sections. To address this, the Association of Anaesthetists developed the ‘Safe Anaesthesia from Education’ course, together with the World Federation of Societies of Anaesthesiologists. The course is a three‐day obstetric anaesthesia refresher course, which addresses the major causes of maternal death (haemorrhage, eclampsia, sepsis) in Lower- and Middle-Income Countries, and teaches essential skills in anaesthesia during childbirth.
Aim- what did we hope to achieve?
The Association of Anaesthetists and WFSA, in partnership with the Kenyan Society of Anaesthesiologists, delivered a national SAFE obstetric anaesthesia training programme in 2016, with follow‐up and mentorship for course participants. The aim of our study was:
- to assess the educational impact of the SAFE training program
- to investigate whether SAFE training translated into changes in clinical behaviours in the workplace
- to explore what helped and hindered the adoption of recommended anaesthetic care by those who had been trained
Design- what did we do?
The training was delivered in 2016 by physician anaesthetists from East Africa, South Africa, UK and USA, to non-physicians responsible for administering anaesthesia, and from a range of medical centres.
Course attendees were tested before, immediately after, and 3-6 months after the course to measure any change in their knowledge and skills levels. A number of participants were also observed and interviewed to find out how they had changed their clinical practice as a result of the training. We used the COM-B model to understand how the training had impacted their practice. The COM-B model focuses on the importance of three things for behaviour change: Capability (are the able to perform the behaviour?), Opportunity (do they have the opportunity to perform the behaviour?) and motivation (do they want to perform the behaviour?).
Results- what did we find?
In total, data from 103 participants from 66 facilities who attended courses between 2016 and 2017 were included in our analysis. Ninety (87%) participants who were followed up completed knowledge tests. There was a significant improvement in knowledge test score immediately post‐course and at 3–6 month follow‐up.
Eighty‐four of the 103 participants were observed in their workplace and capability, opportunity and motivation‐behaviour framework was used to study the barriers and facilitators to practice change.
Using the COM-B model, we found that capability and motivation were the main factors supporting positive behaviour change, such as team communication and pre‐operative assessment, whereas the main barriers to performing the surgical safety checklist where to do with lack of opportunity, suggesting some areas for improvement.
Our study demonstrates that the Safe Anaesthesia from Education obstetric course is relevant in the low‐resource setting and appears to have a positive impact on clinical practice.
Dissemination- where has this study been shared?
This has been published in the journal Anaesthesia: https://associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/abs/10.1111/anae.15091
Credits- Who was involved in this work?
Behavioural scientists: Jo Hart, Lucie Byrne-Davies,
Partnership staff: M Lilaonitkul, S Mishra, N Pritchard, J Andhoga, P Olang’, EB Kibet, IA Walker.